布-加综合征介入治疗并发股动脉假性动脉瘤的治疗探讨

Clinical analysis of treatment of femoral pseudoaneurysm following interventional therapy for Budd-Chiari syndrome

目的 探讨布-加综合征介入术后并发股动脉假性动脉瘤的原因和治疗措施.方法 回顾分析8例下腔静脉阻塞型布-加综合征患者在介入术中或术后1~2天股静脉（均为右侧）穿刺处出现搏动性肿块,经彩色多普勒超声明确诊断为股动脉假性动脉瘤,显示瘤体大小（长径×短径）为1.2 cm×0.6 cm^10.4 cm×4.8 cm.5例接受超声引导下加压治疗,3例接受超声引导下瘤内凝血酶注射治疗.结果 5例接受超声定位下加压治疗者,时间持续20~40 min,瘤颈闭合和瘤体内血栓形成;3例接受超声引导下瘤内凝血酶注射术（瘤体大小为2.5 cm×1.6 cm、3.8 cm×2.1 cm和10.4 cm×4.8 cm）,其中1例1次成功封闭瘤腔,2例行2次凝血酶注射并持续压迫瘤腔直至愈合,总剂量分别为200 U、300 U和800 U,术后未发生远端动脉栓塞、过敏等并发症.所有患者随访1~6个月无复发.结论 布-加综合征介入治疗并发的股动脉假性动脉瘤,采用超声引导下加压、瘤体内注射凝血酶等治疗取得了良好的临床疗效.

Objective To investigate the reason and treatment of femoral pseudoaneurysm following interventional therapy for Budd - Chiari syndrome （ BCS ）. Methods A retrospective review was conducted on 8 patients presented with BCS caused by obstruction of the inferior vena cava during January 1990 to August 2012, who had been found a pul- satile mass at the area of femoral venipuncture point （ all on the right side） during or 1 to 2 days after interventional thera- py for BCS. The masses were all confirmed to be femoral pseudoaneurysm on the affected side by color Doppler flow image （CDFI） , with its body size （ major diameter x minor diameter） of 1.2 cm x 0.6 cm to 10.4 cmx 4.8 cm. 5 cases re- ceived ultrasound- guided compression repair （UGCR） and 3 cases received ultrasound -guided thrombin injection （UGTI, 500 U thrombin dissolved in 10 ml normal saline）. Results The neck of the aneurysm was sealed off and thrombosis formed in its body in 5 cases after UGCR for 20 - 40 min. Among 3 cases （ the pseudoaneurysm body were 2.5 em x 1.6 em, 3.8 cm x 2.1 em and 10.4 em x4.8 cm respectively） who received UGTI, the cavity of the aneurysm was sealed off successfully in 1 case after UGTI, second UGTI was performed in 2 cases and the cavity of the aneurysm was sealed off. The total dose of thrombin was 200 U, 300 U and 800U, respectively. No complications such as arterial embolism at the distal end of the leg and allergy happened. All of the 8 cases were followed up at 1 to 6 months with no relapse. Conclusion UGCR and UGTI are easy and effective treatment for femoral pseudoaneurysm following interven- tional therapy for BCS.